414004236-6-23-2023-05-CC-DJOO-CTHQHF-20230707121101

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 414004236
Report Date: 06/23/2023
Date Signed: 06/23/2023 12:37:58 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2023 and conducted by Evaluator Marie Rodriguez

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20230501140007

FACILITY NAME:	BUILDING KIDZ (PS)		FACILITY NUMBER:	414004236
ADMINISTRATOR:	NESHEIWAT, SAMANTHA		FACILITY TYPE:	850
ADDRESS:	39 E. 39TH AVENUE		TELEPHONE:	(650) 212-5439
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	70	CENSUS: 34	DATE:	06/23/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Jennifer Massis and Samantha Nesheiwat		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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- Child in care sustained fracture due to lack of supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced subsequent visit to close a complaint. Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced subsequent visit to close a complaint. LPA met with Teacher Samar Bouri and explained purpose of inspection. Executive Director Jennifer Massis and Director Samantha Nesheiwat arrived a short time later. Present at the school were the directors, 6 teachers, and 34 preschool aged children.

During the course of the investigation, LPA conducted a physical plant tour of the facility, conducted interviews, and reviewed records. LPA observed appropriate staff to child ratio at all times while indoors and outdoors. LPA observed a teacher positioned near the play structure while children are in the outdoor play area. Per interviews conducted, Child C1 was redirected on numerous occasions not to jump off the slide and still did so even with appropriate staff supervising children. Based on the information gathered, there is insufficient evidence to prove a child sustained a fracture due to lack of supervision.

(Continued on LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 05-CC-20230501140007

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BUILDING KIDZ (PS)	FACILITY NUMBER: 414004236
	VISIT DATE: 06/23/2023

NARRATIVE

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(Continued from LIC 9099)

Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is found to be UNSUBSTANTIATED.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

Exit interview was conducted and report was reviewed with Director Samantha Nesheiwat. A copy of the report was provided. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

LIC9099 (FAS) - (06/04)

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